Impact of bronchiectasis on long-term survival in patients with acute exacerbation of chronic obstructive pulmonary disease

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Abstract Background Only few studies have reported the association between bronchiectasis and mortality in patients with Chronic Obstructive Pulmonary Disease (COPD) and the results were controversial. This study aimed at assessing the prognostic influence of bronchiectasis on COPD patients and comparing differences of prognostic influence of different types of bronchiectasis on COPD patients. Patients and methods This study enrolled patients hospitalized for COPD exacerbation between 2013 and 2014. Bronchiectasis was identified on high-resolution computed tomography (HRCT) within 2 years prior to this hospitalization due to COPD exacerbation and Smith score was used to determine the extent of bronchiectasis. Clinical data were obtained from electronic inpatient medical record. The survival data were obtained through telephone follow-up or electronic medical record. Cox regression analysis was used to assess the prognostic influence of bronchiectasis on COPD patients. Results 748 COPD patients were included in this study. 318 patients were identified to have bronchiectasis. During a median follow-up time of 46 months, 624 COPD patients completed follow-up. There were 210 deaths, 112 of whom were comorbid bronchiectasis patients. Comorbid bronchiectasis patients revealed higher mortality than without bronchiectasis patients in 3 years and the whole follow-up, other than in hospital, 1 year and 2 years. The presence of bronchiectasis and its severity were independently associated with increased mortality of COPD patients. The presence of cystic/varicose bronchiectasis revealed higher mortality than cylindrical bronchiectasis and was independently associated with increased mortality of comorbid bronchiectasis patients. Conclusions The presence of bronchiectasis and its severity were independently associated with increased risk of all-cause mortality and mainly affected the long-term mortality of COPD patients. The presence of cystic/varicose bronchiectasis predicted higher death risk of COPD patients.